Pregnancy outcomes in women with anorexia nervosa: a population-based study and analysis of a matched cohort

Research question: What implications does anorexia nervosa have on pregnancy outcomes in a US population? Design: A retrospective, population-based study using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A dataset of all deliveries between 2004 and 2014 inclusively was created. The population was divided into women with anorexia nervosa (n = 214) and women without anorexia nervosa (n = 9,096,574), and a cohort matched 1:4 with anorexia nervosa for age, race, medical insurance type and income quartile. Delivery and neonatal outcomes were compared between the two matched groups and with the control group of deliveries. A multivariable logistic regression analysis, controlling for statistically significant baseline characteristics, explored associations between anorexia nervosa and delivery, and neonatal outcomes. Results: Compared with the entire group, women diagnosed with anorexia nervosa were more likely to be white, smokers, of higher income or diagnosed with another psychiatric disorder. In the unmatched comparison, women with anorexia nervosa had a higher frequency of preterm delivery (adjusted odds ratio [aOR] 2.98 CI 1.86 to 4.76, P < 0.001), placental abruption (aOR 3.41 CI 1.38 to 8.40, P = 0.008) and small for gestational age (SGA) neonates (aOR 5.32 CI 3.12 to 9.09, P < 0.001). In the matched comparison, preterm delivery (aOR 5.31, CI 3.02 to 9.32, P < 0.001) and SGA neonates were significantly higher in the anorexia nervosa group (aOR 4.69 CI 2.6 to 8.41, P < 0.001), providing results similar to the unmatched comparison. Conclusion: Healthcare providers, specifically fertility specialists, should be aware of the magnitude of adverse outcomes related to pregnancy in women with anorexia nervosa.

Automated summary

This population-based study investigated the implications of anorexia nervosa on pregnancy outcomes in a US population. The data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were used to create a dataset of deliveries between 2004 and 2014. Women with anorexia nervosa were compared to those without, and associations between anorexia nervosa and delivery and neonatal outcomes were explored. The results showed that women with anorexia nervosa had higher rates of preterm delivery, placental abruption, and small for gestational age neonates compared to the control group. Healthcare providers, especially fertility specialists, need to be aware of these adverse outcomes in women with anorexia nervosa.